Many proponents of advance medical directives (ADs) (e.g., living wills) recommend that primary care physicians routinely initiate AD discussions with their healthy elderly outpatients. Before policies are developed based on this recommendation, however, research must examine the impact of physician-initiated AD discussions on patients and how best to structure these discussions to optimize their utility for honoring incapacitated patient's treatment wishes. The specific goal of this proposal is to further analyze data from a completed randomized control trial in which 100 outpatients age 65 and over from an ambulatory primary care practice had either an AD discussion or a control/Health Promotion (HP) discussion with their physician. The AD discussion included the provision of scripted information about ADs, cardiopulmonary resuscitation (CPR), and artificial nutrition and hydration (ANH). AD discussion patients indicated their preference for receiving CPR and ANH in tow serious medical scenarios. The physician-patient discussions were videotaped. Prior to the discussion, data were collected on patients' demographic, medical, and psychological characteristics and physicians completed measures of their attitudes toward ADs and predicted patients' life-support preferences. Patients' self-reported affective state and life-support attitudes were measured before, immediately after, and one week after the discussion. Initial analyses of these data have focused on patients' affective reactions to the physician-initiated AD discussion. These analyses show that AD discussions with healthy elderly outpatients produce no adverse emotional affects and a variety of positive outcomes. The proposed analyses will examine: 1) physician predictions of patient life-support preferences, 2) patients' comprehension of the AD discussion, and 3) the videotapes of the physician-patient discussions. Three questions concerning physician- initiated AD discussions will be addressed: 1) How accurately are physicians able to predict patients' life-support preferences and what characteristics of the patient, physician, and physician-patient relationship are associated with predictive accuracy?, 2) How well do patients comprehend physician-initiated AD discussions and what characteristics of the patient, physician, and physician-patient relationship are associated with level of comprehension?, and 3) What aspects of physicians' and/or patients' behavior during the AD discussion are associated with patients' post-discussion comprehension and affective reactions?